Purpose of Review
Providing rehabilitation to patients with cancer can be challenging due to the medical complexity associated with the illness and its treatments. This article provides the reader with a summary of frequently encountered medical conditions in the cancer population and associated safety considerations and precautions. An update on treatment modalities commonly used for symptom management is also presented.
Recent Findings
Cancer and cancer treatments can cause changes in multiple organ systems. Special considerations and precautions are necessary to provide safe and effective rehabilitation. Physical modalities can be used as monotherapy or adjunct to treatment for common cancer-related side effects with recent studies noting benefit with a variety of modalities.
Summary
Detailed assessment of the cancer patient is necessary before implementing a rehabilitation program. Understanding cancer and side effects of treatments, including newer options, are necessary to provide safe care.
Background: Although the incidence of major pediatric lower limb loss secondary to either congenital deficiencies or acquired amputations is relatively low, the prevalence of lower limb loss among children in the United States (US) remains unknown. Objectives: To estimate the prevalence of major lower limb loss, and the associated prosthetic services use and costs among commercially-insured children in the US. Study design: Observational, retrospective, longitudinal cohort study. Methods: The IBM MarketScan® Commercial Database was used to identify children (<18 years) with major lower limb loss in the US between 2009 and 2015. Descriptive statistics were used to characterize pediatric cases according to sociodemographic and limb loss characteristics. Multivariate models assessed factors associated with annual prosthetic visits, prosthetic-related costs, and overall medical costs. Results: Of the 36.5 million children in the MarketScan database, 14,038 had a major lower limb loss, yielding a prevalence estimate of 38.5 cases per 100,000 commercially insured children in the US during the 7-year study period. Congenital deficiencies accounted for 84% of cases, followed by 13.5% from trauma. Only 10.1% had at least one prosthesis-related visit during any 12-month period following their cohort entry. Among those, the mean annual prosthetic-related costs ranged from $50 to $29,112 with a median annual cost of $2778 (interquartile range = $4567). Annual coinsurance and copays for prosthetic services accounted for nearly half of the overall annual out-of-pocket outlays with medical care for these children. Conclusion: Pediatric lower limb loss results in lifelong prosthetic needs. This study informs insurers and policy-makers regarding the prevalence of these patients and the medical costs for their care.
Background:
Over 50% of individuals with cancer will experience pain at some point from diagnosis to treatment. Many of these individuals are elderly and frail, further complicating their pain management. The purpose of this review is to synthesize what is known about the assessment and management of cancer pain in the frail, elderly individual.
Methods:
A scoping review was undertaken using the methodology outlined by Arksey and O'Malley with reporting as defined by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Three databases were searched for articles that met our inclusion criteria and resulted in a total of 2007 articles of which 6 were ultimately included in our review.
Results:
Of the 6 studies included 5 focused on individual related characteristics and 1 study focused on provider factors. These studies found that frail and elderly individuals with cancer are at risk of unmanaged pain and polypharmacy; however, the prevalence remains unclear. Additionally, treatment of cancer pain in this population is impacted by clinicians' backgrounds and comfort levels in pain assessments.
Discussion:
The frail, elderly individual with cancer is at risk for pain. Little is currently known about how to accurately measure and safely treat pain in this population.
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